New York Home Care Agencies and the ACA Employer Mandate: Who Has to Offer Coverage

Is your agency an Applicable Large Employer?

Count full-time employees (30+ hours a week or 130+ a month) and add full-time equivalents from everyone else: total part-time hours in the month ÷ 120. Average the monthly totals over the prior calendar year.

Worked example. A New York agency has 35 caregivers and office staff at 130+ hours a month, plus 48 part-time caregivers averaging 45 hours a month.

• Full-time employees: 35
• Part-time FTEs: 48 × 45 = 2,160 hours ÷ 120 = 18
• Total: 53 → the agency is an ALE.

Two home care specifics. Entities under common ownership are combined under the controlled-group rules, so multiple agency LLCs or franchise territories with the same owners count as one employer. And caregivers with variable hours can be classified using the IRS look-back measurement method (a 3–12 month measurement period followed by a stability period), which is how most agencies decide who must be offered coverage without re-running the math every month.

IRS, Identifying full-time employees ↗

What an ALE owes if it doesn't comply (2026 amounts)

• 4980H(a), no offer: if you don't offer minimum essential coverage to at least 95% of full-time employees and any one of them gets a subsidy on NY State of Health, you owe $3,340 per full-time employee minus the first 30. In the example above: (35 − 30) × $3,340 = $16,700 a year, triggered by a single subsidized caregiver.
• 4980H(b), unaffordable offer: if you offer coverage that's unaffordable or below minimum value, you owe $5,010 for each full-time employee who enrolls in a subsidized marketplace plan.

IRS Rev. Proc. 2025-26 ↗

Which New York caregivers can actually trigger a penalty

Penalties are only triggered when a full-time employee actually receives a premium tax credit on the marketplace. Who can get one depends on income:

With federal H.R. 1 funding cuts ending New York's 1332 waiver, Essential Plan eligibility dropped from 250% to 200% FPL on July 1, 2026. Roughly 450,000 New Yorkers - including many caregivers - lost EP coverage and must pick a qualified health plan by August 30, 2026; those who claim premium tax credits can now trigger 4980H(b) penalties for ALE agencies that don't offer affordable coverage. info.nystateofhealth.ny.gov ↗

New York expanded Medicaid; adults to 138% FPL qualify, with the Essential Plan covering 138-200% FPL at little or no premium. kff.org ↗

New York runs its own exchange, NY State of Health, which also administers the Essential Plan (Basic Health Program) used heavily by home care workers. nystateofhealth.ny.gov ↗

What counts as "affordable" for a New York caregiver in 2026

Coverage is affordable if the caregiver's self-only contribution is no more than 9.96% of household income. Since you can't know household income, the IRS provides three safe harbors:

The New York-specific point: because the state minimum wage is $16.00, the rate-of-pay safe harbor gives New York agencies far more room than the $129.89 FPL figure most national guides quote. An agency paying $16.00 can charge up to $207.17 a month for self-only coverage and still be safe from the (b) penalty. Use each caregiver's actual lowest hourly rate; where local minimums are higher, the ceiling is higher still.

A CHOICE (formerly known as ICHRA) counts as an offer of coverage. It's affordable if the caregiver's cost for the lowest-cost self-only silver plan on NY State of Health for their rating area, minus your monthly allowance, stays within the 9.96% test.

IRS Rev. Proc. 2025-25 ↗ · IRS HRAs ↗ · minimum wage → see the New York wage & hour page

2026 federal compliance calendar (New York adds nothing to this list)

There is no New York filing, no New York furnishing deadline, and no New York penalty. If you also employ caregivers who live in California, New Jersey, Massachusetts, Rhode Island, or DC under a self-insured plan, those states' reporting rules may apply to those employees; see the state-by-state ACA hub.

IRS, Information reporting by ALEs ↗

New York continuation coverage (mini-COBRA)

New York's continuation law covers insured groups of any size and runs up to 36 months - double federal COBRA - relevant to agencies with fewer than 20 employees. dfs.ny.gov ↗

Other New York mandates that touch home care agencies

These aren't ACA rules, but they land on the same desk.

• DBL + Paid Family Leave. New York employers must carry statutory Disability Benefits (DBL) coverage and NY Paid Family Leave insurance; PFL provides up to 12 weeks at 67% of wages (capped at a percentage of the state average weekly wage), funded by employee payroll deductions. paidfamilyleave.ny.gov ↗
• NY Secure Choice - 2026 deadlines. The now-mandatory NY Secure Choice Savings Program covers private employers with 10+ employees, in business 2+ years, without a retirement plan. Registration deadlines: 30+ employees by March 18, 2026; 15-29 by May 15, 2026; 10-14 by July 15, 2026. Exempt employers must certify their exemption online. newyorksecurechoice.com ↗

For completeness: New York has no state individual mandate or employer 1095 filing requirement; only federal ACA reporting applies. tax.ny.gov ↗

Frequently asked questions

We have 48 full-time caregivers and a handful of part-timers. Are we under the threshold?

Probably not. Add the part-timers' monthly hours and divide by 120. Two part-timers at 120 hours a month between them add one FTE, which puts you at 49; a third pushes you to 50 and ALE status the following year.

Does New York require us to file anything about health coverage with the state?

No. New York has no state individual mandate and no state 1095 reporting. Your only filing is federal (1094-C/1095-C) if you're an ALE.

Can a caregiver on Medicaid trigger a penalty against us?

No. Penalties are triggered only by full-time employees who receive a marketplace premium tax credit. New York caregivers below 200% FPL qualify for Medicaid or the state program noted above instead, so they can't trigger 4980H. Caregivers between 200% and 400% FPL can.

We pay the New York minimum of $16.00. What's the most we can charge for self-only coverage?

Under the rate-of-pay safe harbor, $16.00 × 130 hours × 9.96% = $207.17 a month in 2026. That's well above the $129.89 FPL figure, so rate of pay is the better harbor for New York agencies.

Does a CHOICE (ICHRA) count as offering coverage in New York?

Yes. An affordable CHOICE (ICHRA) satisfies both the 4980H(a) offer requirement and the (b) affordability test, measured against the lowest-cost silver plan on NY State of Health for each caregiver's rating area.

We're under 50 FTEs. Is there any reason to offer coverage?

No mandate applies, but agencies under 50 commonly offer a MEC or CHOICE (ICHRA) to reduce turnover, and the same affordability math determines what you can charge caregivers.